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24-hour electrocardiogram before and during cisapride treatment in neonates and infants

Samuel A Zamora1, Dominique C Belli, Beat Friedli

  • 1Gastroenterology Unit, Department of Pediatrics, University Hospital, Geneva, Switzerland. Samuel.Zamora@hcuge.ch

Biology of the Neonate
|January 20, 2004
PubMed

Insights

Cisapride prolonged the corrected Q-T interval (QTc) in preterm infants but did not cause significant arrhythmias. The drug lowered heart rates and reduced bradycardia in neonates with reflux.

Area of Science:

  • Neonatal cardiology
  • Pediatric pharmacology

Background:

  • Gastroesophageal reflux disease is common in neonates, presenting as apparent life-threatening events, apneas, and bradycardias.
  • Cisapride is used to treat gastrointestinal motility disorders in infants.

Purpose of the Study:

  • To prospectively evaluate the effects of cisapride on heart rate and rhythm in term and preterm neonates and infants.
  • To assess changes in corrected Q-T interval (QTc), Q-T dispersion (QTd), heart rate variability, and heart rhythm.

Main Methods:

  • Prospective study involving standard and 24-hour ECG recordings in 31 neonates (14 term, 17 preterm) with gastroesophageal reflux disease.
  • Measurements of QTc, QTd, heart rate, heart rate variability, and heart rhythm were taken before and after 3 days of cisapride treatment (0.8 mg/kg/day).

Main Results:

  • Cisapride significantly increased QTc in preterm infants (408 to 433 ms).
  • While QTc increased, QTd remained normal, and no clinically relevant arrhythmias were documented.
  • Cisapride decreased peak and mean heart rates in all subjects, increased minimal heart rate in preterm infants, and reduced bradycardia episodes.

Conclusions:

  • Cisapride can prolong ventricular action potential duration in preterm infants, but QTd and rhythm remained largely unaffected in this cohort.
  • The drug demonstrates a beneficial effect by lowering heart rates and reducing bradycardia in infants with reflux.
  • Further investigation into cisapride's cardiac effects in neonates is warranted, especially in preterm infants.

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